The word asthma
originates from an ancient Greek word meaning panting. Essentially,
asthma is an inability to breathe properly. When any person inhales,
the air passes into the lungs through progressively smaller airways
called bronchioles. The lungs contain millions of bronchioles,
all leading to alveoli, microscopic sacs where oxygen and carbon
dioxide are exchanged. Asthma is a chronic condition in which these
airways undergo changes when stimulated by allergens or other environmental
triggers that cause patients to cough, wheeze and experience shortness
of breath (dyspnoea). Asthma appears to have two primary stages
: hyper-reactivity (also called hyper-responsiveness) and the inflammatory
response.

Hyper-reactive
Response

In the hyper-reactive
response, smooth muscles in the airways narrow excessively in response
to inhaled allergens or other irritants. It should be noted that
the airways in everyones lungs respond by constricting when exposed
to allergens or irritants, but people without asthma are able to
breathe in deeply to relax the airways and rid the lungs of the
irritants. When asthmatics try to take those same deep breaths,
their airways do not relax and the patients pant for breath. Smooth
muscles in the airways of people with asthma may have a defect,
perhaps a deficiency in a critical chemical that prevents the muscles
from relaxing.

Inflammatory
Response

The hyper-reactive
stage is followed by the inflammatory response, in which the immune
system responds to allergens or other environmental triggers by
delivering white blood cells and other immune facts to the airways.
Although designed to fight infection, in excess these immune factors
can cause significant damage. These so-called inflammatory factors
cause the airways to swell, to fill with fluid, and to produce
a thick sticky mucous. This combination of events results in wheezing,
breathlessness, inability to exhale properly, and a phlegm-producing
cough. Inflammation appears to be present in the lungs of all patients
with asthma, even those with mild cases, and plays a key role in
all forms of the disease.

WHAT CAUSES ASTHMA IN CHILDREN
?

Factors contributing to the
worldwide increase of Asthma.

Asthma has dramatically
risen worldwide over the past decades and experts are puzzling
over the cause of this phenomenon. The mechanisms that cause asthma
are complex and vary among population groups and even individuals.
Many asthma sufferers also have allergies, and researchers are
investigating the events that occur in both these conditions. Not
all people with allergies have asthma, however, and not all cases
of asthma can be explained by allergic response. Other contributing
causes are being investigated. Asthma is most likely a result of
genetic susceptibility, which probably involves several genes and
various environmental triggers, such as infections, dietary patterns,
air pollution, and allergens. Some experts observe that children
are spending more time indoors watching televisions, playing video
games, or using the computer so that they are overexposed to indoor
allergens. The trend of making homes more energy-efficient may
result in dust mites being trapped inside them. Other facts for
the increase in asthma cases may include the increased survival
of low-birth-weight babies (who may be more susceptible to asthma).
Asthma related disorders, including allergies, sinusitis, and ear
infections, are also on the rise, suggesting that airborne or environmental
factors are at work, and many experts believe asthma is actually
undiagnosed.

Immune Factors Involved in
the Allergic Response.In people who have
asthma caused by an allergic response, various airborne allergens
or other triggers set off a cascade of events in the immune system
that lead to inflammation and hyper-reactivity in the airways.

Genetic FactorsAbout one third
or all the persons with asthma share the problem with another member
of their immediate family. Genetic factors appear to play a more
important role than environmental factors or allergies in such
families. The condition may be more likely to be passed to children
from the mother than from the father. One study reported, however,
that the risk of having an asthmatic child was six times higher
if both parents had a history of asthma than if just one had the
disease. Although specific genes for asthma have not yet been identified,
research is progressing towards this goal.

Exercise-Induced Asthma.About 40% to 90%
of asthma cases are exercise-induced asthma (EIA), in which exercise
triggers coughing, wheezing, or shortness of breath. It occurs
most often in children and young adults and during intense exercise
in cold dry air. EIA is triggered only by exercise and is distinct
from ordinary allergic asthma in that it does not produce a long-term
increase in airway activity (as allergic asthma does) so people
who only have EIA do not require long-term maintenance therapy.
(Some people, however, have both types). There is some evidence
that patients with EIA may also experience an asthmatic response
hours after physical activity; more research is needed to confirm
this.

It should be noted
that asthma is no reason to avoid exercise. About 10% of US athletes
who participated in the 1996 Olympics were asthmatic. (Similar
results were reported in the 1984 Olympics). Some studies are indicating
that long-term exercise may help control asthma and reduce hospitalization.
Asthmatic children should be encouraged to swim and play sports,
such as baseball, that will present less difficulty for them. Intense
activities lasting less than two minutes, such as sprinting or
competitive swimming, are less problematic than longer exercises.
Summer sports causes less stress than winter ones. Thorough warm-up
period before vigorous exercise can help considerably in limiting
bronchial narrowing and obstruction. Parents of children with exercise-induced
asthma should consult their physicians for an exercise program
suited to their specific conditions.

InfectionsEarly Respiratory
Infections. The organisms Chlamydia pneumoniae, Mycoplasma pneumoniae,
adenovirus, and the respiratory syncytial virus are major causes
of respiratory infections and are becoming important suspects in
many cases of severe adult and childhood-onset asthma. One 1999
British study, for example, found a significant link between respiratory
infections in mothers during pregnancy and asthma in their children.
In one study, patients whose asthma was initiated after infections
had a more severe condition than those whose asthma was due to
other causes, but asthma caused by infections did not last as long
(5.6 years compared to 13.3 years). Rhinovirus, or the common cold
virus, can exacerbate asthma attacks and has been reported to be
the most common infectious agent associated with asthma attacks.
In one study, it was associated with 61% of asthma exacerbations
in children and 44% in adults. Some research suggest that colds
promote allergic inflammation and increase the intensity of airway
responsiveness for weeks.

Homoeopathy is a
system of medicine which has proved to be a tremendous success
in improving the bodys immunity level. Infact, it enhances the
bodys immunity in the most natural way. Thus giving power to the
body to fight the diseases.

Homoeopathy treats
Asthma with a broader and long term curative view. During the course
of H treatment if my patient needs bronchodilators, inhalers
or nebulizers, I dont stop them because my first aim is to give
relief to the child during acute difficulty in breathing.

Each child or individual
is born with a predisposition and interacts with the environment
to evolve a disposition. The disposition constantly tries to strike
a balance with the environment. Certain dispositions under environmental
stresses have a tendency to develop asthma in childhood when the
balance between the childs health and environment is lost the
immunity goes down and diseases enter the body. Expression of diseases
depends upon the sensitivity of the individual and the inherent
predisposition. Thus in homoeopathy we treat each individual on
his predisposition like previous illnesses, allergies, family history,
temperament, constitution his (childs) likes and dislikes, activities,
educational or emotional stress.

Asthma with Inflammatory
ResponseAsthma could be
prevented or its intensity reduced by controlling the infection
and the commonest infection is sore throat. Child complaints of
sore throat with a sensation of something stuck in it. This sensation
doesnt disappear on swallowing, in fact swallowing is very painful
and pain extends to the ears. At times there is loss of voice with
rattling in the chest and profuse yellowish greenish expectoration.
Child feels very cold and wants to be covered. All the above complaints
are worse in chilly dry weather or drinking chilled (iced) drinks.

Choking cough and
sore throat gradually leads to difficulty in breathing. To prevent
this (asthma attack) start the child on Hepar Sulph 200, 5 pills
every 2 hourly. Hepar Sulph will immediately control the infection
and thus prevent an asthma attack.

Merc. Sol. Throat
problem starts mainly due to dust, environmental gases and every
change of weather. At first the cold settles in the eyes and nose
and then the throat feels sore with a dirty coated tongue and foul
smell from the mouth. Tiny ulcers form in the mouth and throat
causing inflammation and pain.

There are number
of homoeopathic medicines for the above conditions depending upon
the signs and symptoms of the child.

Genetic Factors.We homoeopaths pay
great attention to family history. If there is a family history
of asthma, skin disease (Eczema), tuberculosis, cancer we take
these factors in account while prescribing medicine. There are
specific polycrest (Broad acting) medicines which try to minimise
the bad effects of weak genes and improves the quality of those
genes. A Homoeopath always gives the correctly indicated Poly crest
remedy (once the acute attack is over) to improve the immunity
of body and remove or minimise the effect of genes for asthma.

Reduced Incidence of Common
Childhood Infectious Diseases. Another theory for the dramatic
increase in childhood asthma appears to be a contradiction. It
blames the higher rate of asthma on childhood immunizations that
have nearly eliminated certain infectious diseases, such as measles
and whooping cough. Experts postulate that in some children who
are vaccinated against these diseases, TH2 cells remain active
and trigger the inflammatory events leading to asthma. Of some
support for this theory are studies reporting that being a part
of a large family reduces the risk of childhood asthma; children
with many siblings are exposed to infections, which might increase
immune factors that impede allergies.

We come across a
number of children with chest allergy after they have been vaccinated.
Specially whooping cough and measles vaccines have at times given
long term side effects such as cold, cough, throat infections which
may lead to asthma.

In Homoeopathy we
have special vaccines to reduce side effects for these vaccines
and reduce their toxicity.

Pertussin vaccine
200, 5 pills once a week for 6 weeks will reduce repeated cough
attacks if developed after whooping cough vaccine.

Morbillinum 200,
5 pills once a week for 6 weeks should be given when the child
develops chronic cold, cough and throat infection after Measles
vaccine.

Many more Homoeopathic
vaccines are used to minimise side effects of vaccines.

Other Contributing Medical
Conditions

Hyperacidity or
Gastroesophageal reflux disease (GERD), the cause of heartburn,
is common in many asthmatic patients and is widespread among children
with hard-to-control asthma. GERD may trigger asthma in many cases
by spilling acid into the airways that trigger a hyper-reactive
response. GERD may be suspected in patients who do not respond
to asthma treatments, whose asthma attacks follow episodes of heartburn,
or whose attacks are worse after eating or exercise. In such cases,
treating the heartburn may also resolve asthma.

Nowadays hyperacidity
in children is on an increase because of the junk food they eat.
Nux Vomica tries to reduce the harmful effects of junk food, helps
in digestion, decreases the amount of extra acid produced, sour
and bitter eructations, nausea and vomiting. Nux Vomica tries to
help the body by removing junk food effect via rectum. Nux Vomica
200, 5 pills 4 times help.

Sinusitis : Almost half of children and adults with
allergic asthma have sinus abnormalities, and in various studies
between 17% and 30% of asthmatic patients develop true chronic
sinusitis. The presence of sinusitis, however, does not appear
to increase the severity of asthma.

WHY DO CHILDREN
GET ASTHMA ?

Asthma has dramatically
increased worldwide over the last few decades. It is rising most
rapidly in children under age four; according to a 1999 study the
prevalence of asthma in young children increased by 160% between
1980 and 1995. At least five million American children are thought
to have asthma today, almost half of whom may be undiagnosed, elevating
asthma to the status of an unrecognised epidemic. Results from
one survey indicated that more than 7% of American children between
the ages of five and 14 have asthma. About half of all cases of
asthma develop before the age of 10, and another third before age
40. Among younger children, asthma develops twice as frequently
in boys as in girls, but after puberty it may be more common in
girls.

Coexisting allergies

About 75% to 80%
of children with asthma have allergies and studies indicate that
the more indoor allergens a child is allergic to, the higher the
risk for severe asthma. About 8% to 10% of children with asthma
also have food allergies; these children also appear to have a
high risk for very serious reactions to such food. In infants and
toddlers, allergy to egg appears to be a major predictor of asthma.
Asthma and non-seasonal or seasonal allergic rhinitis (hay fever
or rose fever caused by pollen allergies) often coexist together.
However, although most people with asthma have a history of allergic
rhinitis, only 1% to 20% of children with allergic rhinitis actually
develop asthma. The connection between allergies and asthma is
likely be a common cause rather than one causing the other.

Certain food items
like milk, egg and nuts plays a very major allergic role. To reduce
these allergic reactions certain homoeopathic medicines like Aethusa,
Calcarea Carb, Sepia, Ipecac, Sulphur, Thuja can be used according
to each individuals symptoms and signs.

Issues Surrounding Birth

Infants of low birth
weight are at higher risk for lung problems and asthma. One study
suggests that children born in winter are at greater risk for asthmatic
allergies to cockroaches than children born at other times of the
year. Children who are fed exclusively breast milk (rather than
other milk) for at least their first four months of life are significantly
less likely to develop asthma than other children.

Wheezing in
Infancy

A few studies indicate
that the risk for asthma is high in children under five who wheeze,
have frequent chest colds, or have a chronic cough. It should be
noted that half of all children and infants wheeze at some time,
but few develop asthma. Most babies who wheeze still have underdeveloped
airways, which become normal as they grow. Clues to a risk for
future asthma may be persistent wheezing, a rattling sound when
infants cough, rapid breathing, and frequent respiratory illnesses.
Wheezing infants who develop asthma are apt to have a family history
of allergies and asthma. They may also have mothers who smoke.
Research is underway to determine which wheezing babies are at
risk for future asthma and which ones arent.

Other Risk Factors

Damp Homes : Studies
from different parts of the world reported that children who live
in damp homes have a much higher risk for asthma than those who
dont. Damp homes or damp climate can cause lots of difficulties
to asthma patients. For allergy to damp climate there are number
of homoeopathic medicines, few are as under :-

Natrum Sulph :- This individual
is very sensitive to rainy season, near the sea, in general water
in any form. The child develops cold, cough at times wheezing during
change of weather from dry to wet, by eating certain plants or
fruits growing near water (sea, river) living in damp houses, basements.

It starts with nasal
cold with thick yellow discharge from nose. Gradually a cough develops
with rattling of mucus in chest along with wheezing and difficulty
in breathing.

Calcarea Carb : Child is
chubby, there is a tendency towards lots of perspiration specially
around the neck, child wets the pillow during sleep and catches
cold during cold rainy season and feels very chilly specially palms
and feet are icy cold. Nose feel dry and stuffy with tiny blister
like ulcers in nasal cavity, discharge from the nose is foul smelling,
yellowish thick. There is dry troublesome cough especially at night
with hoarseness of voice. Feels suffocated at night with tightness
of chest.

Day Car Centres :-
Some experts note that more young children are in day care, where
respiratory infections are common, and a 1999 study found a direct
link between attendance at day care centers and an increased risk
of asthma later in childhood, with earlier infections playing an
important role. It should be noted that some studies suggest that
immunizations that reduce the incidence for early childhood diseases
may affect the immune system and increase the risk for asthma.
More research is needed to resolve these apparent contradictions.

Obesity: In both adults and
children the incidence of obesity has been increasing in parallel
with the rise in asthma over recent years. Studies report a strong
association between the two conditions, but it is not clear if
one causes the other. Some experts suggest that excess weight pressing
on the lungs can cause a hyper-reactive response. Others believe
that asthma itself results in low physical activity rates with
subsequent weight gain.

Mental Health:- Research
indicates that poor mental health of parents and children are significant
predictors of more severe symptoms in childhood asthma.

WHAT ARE THE
SYMPTOMS OF ASTHMA IN CHILDREN?

The primary symptoms
of asthma are coughing, wheezing and shortness of breath (dyspnoea).
In children with asthmatic symptoms, it is particularly important
to first consider as a possible cause inhaled foreign objects such
as peanuts, viral infections such as croup and bacterial infections,
which may be accompanied by high fever and progress rapidly. Any
child who has frequent coughing or respiratory infections should
be checked for asthma.

Asthma is classified
as mild when a child experiences one or two brief episodes weekly.
In moderate asthma, the episodes occur more than twice weekly,
and severe asthma is marked by continuous symptoms. Of great concern
are studies reporting that people, including children, with life-threatening
asthma, become insensitive to symptoms and may not recognise dangerous
indicators. Asthma is usually worse at nigh, and attacks often
occur between 2 and 4 a.m. Asthma occurs primarily at night in
as many as 75% of asthma patients. This night time propensity is
due to a number of reasons:-chemical and temperature changes in
the body during the night increases the inflammation and narrowing
of the airways, delayed allergic responses can occur from exposure
to allergens during the day, and toward the early morning, the
effect of inhaled medications may wear off and trigger an attack.
Some evidence suggests that sleep itself may play a role in the
worsening of asthma at night; further research is needed.

The classic symptoms
of an asthma attack are coughing, wheezing, and shortness of breath
(dyspnea). Wheezing when breathing out is virtually always present
during an attack. Usually the attack begins with wheezing and rapid
breathing and, as it becomes more severe, all breathing muscles
become visibly active. Irritation of the nose and throat, thirst
and the need to urinate are common symptoms and may occur before
an asthma attack begins. Some people first experience chest tightness
or pain or a non-productive cough that is not associated with wheezing.
Chest pain, in fact, occurs in about three quarters of patients;
it can be very severe and its intensity is unrelated to the severity
of the asthma attack itself. The neck muscles may tighten and talking
may become difficult or impossible. The end of an attack is often
marked by a cough that produces a thick, stringy mucus. After an
initial acute attack, inflammation persists for days to weeks,
often without symptoms. (The inflammation itself must still be
treated, however, because it usually causes relapse.)

Asthma symptoms
vary in severity from occasional mild bouts of breathlessness to
daily wheezing that persists despite taking large doses of medication.
Without effective treatment during an attack, exhaustion may worsen
respiratory function, and in rare cases, a life-threatening situation
can occur. As the chest labours to bring enough air into the lungs,
breathing often becomes shallow. Lacking sufficient oxygen, the
skin becomes bluish, the flesh around the ribs of the chest appears
to be sucked in, and the patient may begin to lose consciousness.

HOW SERIOUS IS
ASTHMA IN CHILDREN

Severity of Acute
Attacks

Asthma is the third
major cause of hospitalization in children under 15. Asthma is
especially serious in children, particularly those younger than
five, because their airways are very narrow. These immature airways
have less reserve for air exchange and respond as well as adults
to bronchodilators (drugs that open the airways). Underestimating
the severity of an acute attack poses the greatest threat to children
with asthma. Unfortunately, one study of children found that nearly
40% of them were unaware of asthmatic symptoms when they occurred.
Sadly, the hospitalization and fatality rates among children and
young adults with asthma are on the rise; these figures almost
doubled between 1980 and 1993. African American children have more
than six times the death rate of Anglo-Americans in the age groups
of four and under and 15 to 24 years. Factors associated with an
increased risk of death from asthma in children include previous
life threatening episodes of asthma in children include previous
life threatening episodes of asthma, lack of adequate and ongoing
care, and significant behavioural problems. Death in children from
an asthma attack is, fortunately, still rare. In the US, about
500 children die each year out of an estimated 5,400 deaths from
asthma; the elderly account for 90% of these deaths.

Long Term Outlook

Although bronchial
responsiveness improves in many children when they reach adolescence,
the improvement is usually not complete, and asthma may flare up
again and remain a problem throughout adulthood. Half of asthmatic
children achieve remission after age 16; in half of these, however,
asthma flares up again in middle age. Children whose condition
is serious enough to require steroids are less likely to outgrow
their asthma than others. There is now some evidence that severe
asthma can cause long lasting damage and possibly permanent scarring.
Many experts urge introduction of anti-inflammatory medications
early on in children with severe conditions. Children adapt well
to living with asthma, however, and even with severe asthma they
can function as well as healthy children in virtually all areas
of life.

Readers are advised
that the medical advice offered in this column pertains to generalised
treatment of condition. Kindly consult your doctor before self-medication.